No abstract

0,65 (0,36-0,73) vs 1,05 (0,67-1,4) % и 0,039 (0,028-0,056) vs 0,063 (0,049-0,076) × 10 9 кл./л соответственно (р = 0,0009, р = 0,003), а также относительной и абсолютной численности плазмоцитоидных дендритных клеток -0,055 (0,04-0,085) vs 0,09 (0,05-0,12) % и 0,0038 (0,0021-0,0054) vs 0,005 (0,0035-0,007) × 10 9 кл./л соответственно (р = 0,0197, р = 0,0414 Introduction. Diagnosis of the kidney transplant cellular rejection in the long-term after transplantation remains a challenge. Usual surrogate markers are not enough sensitive and specific. Rejection is an immune reaction to donor alloantigens. The kidney transplant biopsy to diagnose a dysfunction is an invasive procedure with the incidence of complications about 12.6% and can lead to transplant loss. In this regard, the search of immunological biomarkers for early noninvasive and accurate diagnosis of kidney transplant rejection is an actual task. Material and methods. This is a report of the observational retrospective single-center, comparative case-control study in two groups involving 44 patients who underwent kidney transplantation. The first group (REJ) included the patients with the chronic graft dysfunction caused by a biopsy-confirmed late cellular rejection (22 patients). The second group (STA) included the recipients who had no dysfunction in the posttransplant period (22 patients). Flow cytometry of peripheral blood cells was performed to identify immunophenotyping markers of late cellular rejection after kidney transplantation (we determined subpopulations of T, B lymphocytes, and dendritic cells).Results. As a result of our work, we found significant differences in the absolute count of effector memory T cells making (0.36-0.73) vs. 1.05 (0.67-1.4) % and 0.039 (0.028-0.056) vs. 0.063 (0.049-0.076 , respectively (р = 0.0009, р = 0.003). The numbers of plasmacytoid dendritic cells were also different between the study groups: 0.0038 (0.0021-0.0054) vs. 0.005 (0.0035-0.007) × 10 9 cell/L for an absolute count (р = 0.0414), and 0.055 (0.04-0.085) vs. 0.09 (0.05-0.12

Background. Immune-mediated graft dysfunction with the prevalence of 40% is one of the main problems of modern transplantology. Although percutaneous liver graft biopsy is associated with the development of different complications occurring in 2,2% of cases and can also lead to fatal outcome. Objective – to develop a noninvasive method of graft dysfunction diagnostics in the late post-transplant period using terminally differentiated effector CD8+ T-lymphocytes. Material and methods. There was carried out a single center observational retrospective case-control pilot study, including 45 recipients after orthotopic liver transplantation. According to the postoperative clinical course the patients were stratifed into 2 groups depending on the presence of graft rejection episodes. All patients got immunosuppressive therapy after liver transplantation. Immunophenotypes of the recipients were determined by flow cytometry method. Percutaneous liver graft biopsy was performed in all patients, the results of histological examination were evaluated according to the international Banff schema for grading liver allograft rejection. Results. The results of liver biopsies showed that 14 (31%) out of 45 patients had morphological signs of rejection. The patients with rejection had a reliably higher level of CD8+ Temra cells absolute number (0,23 (0,14;0,38) x 109/l) in comparison to those without rejection (0,09) (0,034;0,16) x 109/l (p=0,034)). The results of ROC-analysis have shown that the most optimal cut-off threshold of CD8+ T-lymphocytes level in immune-mediated graft dysfunction diagnostics in the late post-transplant period is 0,1882x109/l; sensitivity and specifcity in this case being 73,33 (95%; 44,9-92,0) and 96,55 (95%; 82,2-99,4) respectively. Conclusions. The increase of terminally differentiated effector CD8+ T-lymphocytes absolute number has diagnostic importance in patients with immune-mediated graft dysfunction in the late post-transplant period. High sensitivity and specifcity of cut-off threshold of CD8+ Temra lymphocytes absolute number in patients after liver transplantation as well as reliable difference between cell number in patients with normal postoperative period and in patients with immune-mediated graft dysfunction allow considering T-lymphocyte subpopulation as a rejection predictor in the late post-transplant period. The correlation between CD8+ T-lymphocyte absolute number and the results of histological examination makes the former an alternative and, what is more, safe noninvasive method in early diagnostics of liver graft rejection.

Целью нашей работы явилась оценка влияния прекондиционирования ацетилцистеином и севофлюраном на степень ишемически-реперфузионного повреждения печени умерших доноров с признаками маргинальности. Методы и результаты. Дизайн исследованияпроспективное, контролируемое, рандомизированное исследование. Исследование было проведено на 21 доноре с умершим головным мозгом и бьющимся сердцем. В основную группу исследования вошли 11 доноров, в контрольную группу 10. В основной группе определялись морфологические признаки ишемически-реперфузионного повреждения после прекондиционирования ацетилцистеином и севофлюраном, в группе сравнениябез прекондиционирования. Заключение. Применение фармакологического прекондиционирования севофлюраном и ацетилцистеином достоверно привело к уменьшению степени некроза и апоптоза гепатоцитов по сравнению с группой сравнения, т. е. обладает протективным эффектом от ишемически-реперфузионного повреждения. Ключевые слова: севофлюран, ацетилцистеин ишемически-реперфузионное повреждение, маргинальный трансплантат.

Despite the fact that the key role of the liver in the formation of the immune response to injury is not in doubt, the mechanisms of weakening the immune response to infectious and noninfectious lesions in patients with hepatic failure remain unclear. We propose an original hypothesis of forming the ways to limit the amplitude of the systemic inflammatory response in patients with the end-stage liver disease. The basis of the hypothesis is the idea that as a result of reducing the intensity of the natural stimulation of membrane mCD14 receptors by the ligands of infectious nature, the basic mechanism of the systemic immune response induction by liver macrophages (